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A variety of foot and ankle pathologies can impair patient's daily activities, ultimately requiring surgical management. However, with improvements in image-guided intervention, the joints, soft tissues, and osseous structures may be accessible using various percutaneous techniques as a potential alternative therapeutic tool, avoiding the need for surgery with its associated risks and morbidity. This article discusses the potential range of image-guided interventional treatments. Injections, aspiration, biopsies, cryoablation, and radiofrequency ablation are described. Newer novel treatments are also covered. Finally, the common pathologies of Morton's neuroma, Achilles tendinopathy, and plantar fasciitis are addressed.

To evaluate imaging features of soft tissue metastases, technical factors associated with diagnostic yield of image-guided biopsy, and clinical impact of biopsy results on patient outcomes.A total of 1605 image-guided soft tissue biopsies were retrospectively identified from December 2010 to December 2020. Included lesions were histologically proven musculoskeletal soft tissue metastases. Lesions were excluded if intraabdominal, intrathoracic, retroperitoneal, associated with osseous lesions or surgical scar implants or arising from skin or lymph nodes. Image guidance modality, needle size, number of cores, and lesion location, size, and depth from skin were recorded. Patient demographics, malignancy history, biopsy-driven changes in management, and survival rate after biopsy were collected.Forty-six patients met the inclusion criteria with a biopsy diagnostic yield of 44/46 (95.7%). Metastases were most commonly located truncal (82.6%, p 0.001) and intramuscular (78.3%, p 0.001). A total of 37/46 (80.4%) biopsies were US-guided. And 9/46 (19.6%) were CT-guided. There was no significant difference in the number of cores or mean needle gauge between diagnostic and nondiagnostic biopsies. At time of review, 23 (50%) patients were deceased, with a mean survival of 13.5 months after biopsy. The majority (71.7%) of patients had a known primary malignancy at time of biopsy, most commonly lung (24.2%) and breast (24.2%). Overall survival showed no association with anatomic location (p 0.83) or tissue type (p 0.34). The most common biopsy-driven outcome was initiation of chemotherapy, immunotherapy, and/or radiotherapy (52.2%).Image-guided biopsy for soft tissue metastases has high diagnostic yield and commonly influences clinical management. Metastases were most commonly intramuscular in the trunk and are associated with poor prognosis.

SUMMARY Robustness of source parameter estimates is a fundamental issue in understanding the relationships between small and large events; however, it is difficult to assess how much of the variability of the source parameters can be attributed to the physical source characteristics or to the uncertainties of the methods and data used to estimate the values. In this study, we apply the coda method by Mayeda et al. using the coda calibration tool (CCT), a freely available Java-based code (https://github.com/LLNL/coda-calibration-tool) to obtain a regional calibration for Central Italy for estimating stable source parameters. We demonstrate the power of the coda technique in this region and show that it provides the same robustness in source parameter estimation as a data-driven methodology [generalized inversion technique (GIT)], but with much fewer calibration events and stations. The Central Italy region is ideal for both GIT and coda approaches as it is characterized by high-quality data, including recent well-recorded seismic sequences such as L'Aquila (2009) and Amatrice–Norcia–Visso (2016–2017). This allows us to apply data-driven methods such as GIT and coda-based methods that require few, but high-quality data. The data set for GIT analysis includes ∼5000 earthquakes and more than 600 stations, while for coda analysis we used a small subset of 39 events spanning 3.5

It is well known that the use of different methods (e.g., spectral fitting, empirical Green’s functions) for compiling catalogs of source parameters (e.g., seismic moment, stress drop) can results in significant inconsistencies (Baltay et al., 2022). In this study, we present the application of coda-wave source parameters estimation by the Coda Calibration Tool (CCT) to different tectonic settings for closer analysis of the regional variations. CCT implements the empirical methodology outlined in Mayeda et al., (2003), which provides stable source spectra and source parameters even for events recorded by sparse local and regional seismic networks (e.g., Morasca et al., 2022). The main strength of the method is the use of narrowband coda waves measurements, which show low sensitivity to source and path heterogeneity. Additionally, we use independent ground-truth (GT) reference spectra for which apparent stresses are independently calculated through the coda spectral ratio (Mayeda et al., 2007), to break the path and site trade-off. The use of GT spectra eliminates the need to assume source scaling for the region, reducing the impact of a-priori model assumptions on the interpretation of scaling laws of source parameters and their variability. The CCT is a freely available Java-based code (https://github.com/LLNL/coda-calibration-tool) that significantly reduces the coda calibration effort and provides calibration parameters for future use in the same region for routine processing.Recently, several studies applied CCT in very different tectonic contexts, including (1) earthquakes in tectonically active regions (e.g., central Italy, Puerto Rico, southern California, Utah); (2) induced earthquakes in southern Kansas and northern Oklahoma; and (3) moderate-sized earthquakes in stable continental regions such as in Eastern Canada and the United Kingdom. There is excellent agreement between coda-derived Mw in all regions and available Mw from waveform modelling. In some cases, such as central Italy and Ridgecrest, the validation process also involved the comparison with estimates from different empirical techniques, such as spectral decomposition approaches applied to data sets sharing common events with CCT. Overall, there is a general consistency in the scaling laws obtained for different source parameters (e.g., seismic moment, corner frequency, radiated energy and apparent stress), with earthquakes in the UK and Canada having similar and higher apparent stresses than Utah, central Italy, Puerto Rico and southern California, while the induced regions are characterized by the lowest values. In conclusion, the application of a consistent methodological framework and the robustness demonstrated by the results of the seismic coda analysis allow comparison of source scaling relationships for different tectonic settings over a wide range of magnitudes.

High-frequency (∼> 2 Hz) seismic P/S amplitude ratios are well-established as a discriminant to distinguish between natural earthquakes and underground explosions at regional distances (∼200–1500 km). As research shifts toward identifying lower-yield events, work has begun to investigate the potential of this discriminant for use at local distances (

PURPOSE The purpose of this study was to evaluate the mid-term results of posterior medial meniscal root tear (PMMRT) repair through assessment of functional outcome scores and magnetic resonance imaging (MRI). METHODS This was a single-center, retrospective study evaluating patients that had undergone a PMMRT. This was a follow-up to a previously published 2-year outcome study (all original patients were invited to participate). Clinical outcomes included pre- and postoperative International Knee Documentation Committee (IKDC) and Lysholm scores. Root healing, meniscal extrusion, and cartilage degeneration via International Cartilage Repair Society Scale (ICRS) grades were assessed on MRI by two musculoskeletal fellowship-trained radiologists. RESULTS 10 of the original study's 18 patients were able to participate. Mean age and BMI was 48.4 ± 12.0 years and 29.5 ± 4.5, respectively, with mean follow-up 65.5 ± 8.3 months (range 52.0-75.8) (60% female). The IKDC significantly increased from 43 ± 13 preoperatively to 75 ± 16 at 5-year follow-up (p 3 mm of extrusion on preoperative MRI had

Real-time dynamic magnetic resonance imaging (MRI) in the musculoskeletal system touts the ability to perceive in vivo joint kinematics, which is particularly attractive for diagnosing dynamic pathologies such as joint instability or impingement syndromes.The clinical utility of dynamic MRI in the musculoskeletal system is wide ranging, from patellofemoral kinematics to imaging of the hip in femoroacetabular impingement and also dynamic spine imaging. Patellofemoral instability is an ideal diagnostic target, as knee flexion and extension are easily performed in an MRI scanner, and dynamic measurements have been correlated to clinical and static radiologic parameters of instability. Proving the clinical utility of this MRI technique requires rigorous technical standardization and definition of normal patellofemoral motion parameters. Validated imaging methods and rigorously defined normal range data are required to light the path forward, and the video format of dynamic MRI is also ideal for advancing patient-centered care, improving patient literacy on their condition, and offering a potential catalyst for shared decision-making between surgeons and their patients.

Earthquake magnitudes are widely relied upon measures of earthquake size. Although moment magnitude (Mw) has become the established standard for moderate and large earthquakes, difficulty in reliably measuring seismic moments for small (generally Mw

There is a paucity of literature describing MRI patterns of high ankle sprains in pediatric patients. Radiologists should understand MRI patterns of these injuries in both adults and children. To describe normal MRI appearance of pediatric syndesmotic ligaments and compare MRI patterns of high ankle sprains in children versus adults. We reviewed consecutive ankle MRIs performed over 3 years and divided them into three cohorts: a normal pediatric (≤16 years) cohort, and pediatric and adult cohorts with acute/subacute ankle syndesmosis injuries. Our retrospective review assessed interobserver agreement (Cohen kappa coefficient) and normal pediatric syndesmotic anatomy. We compared patterns of high ankle sprains (Fisher exact test) including ligament tears, periosteal stripping, avulsions and fractures. Of the 582 ankle MRIs, we included 25 in the normal pediatric cohort, 20 in the pediatric injury cohort and 23 in the adult injury cohort. The anterior and posterior tibiofibular ligaments all attached to cortex or cartilaginous precursor, while the interosseous ligament/membrane complex attached to the fibrous periosteum in 22/25 (88%) normal pediatric cases. Tibial periosteal stripping at the interosseous ligament/membrane complex attachment occurred in 7/20 (35%) pediatric and 1/23 (4%) adult injury cases (P=0.02). No other statistically significant differences were found. Interobserver agreement ranged from kappa=0.46 to kappa=0.82 (ligament tears), 0.38 to 0.45 (avulsions) and 0.69 to 0.77 (periosteal stripping). The normal interosseous ligament/membrane complex typically attaches to fibrous periosteum rather than bony cortex. Tibial periosteal stripping, usually without tibial fracture, is significantly more common among pediatric high ankle sprains. MRI patterns of high ankle sprains are otherwise not significantly different between children and adults.

To better characterize seismic hazard, particularly, for induced seismicity, there is an increasing interest in methods to estimate moment magnitude (Mw) for small earthquakes. Mw is generally preferred over other magnitude types, but, it is difficult to estimate Mw for earthquakes with local magnitude (ML)

This study aimed to investigate patient-specific, lesion-related, and technical factors that potentially influence diagnostic yield of computed tomography (CT)-guided biopsies of bone lesions.Computed tomography-guided bone lesion biopsies performed over a 2-year period were retrospectively reviewed, including image review and electronic medical records for pathology reports and clinical follow-up. Lesions were tabulated by prebiopsy CT and magnetic resonance imaging features. Patients with nondiagnostic biopsies were assessed for presumptive clinical diagnosis and management.Nondiagnostic pathology results were obtained in 31 of 156 cases (19.87%), among which diagnoses were confirmed by other tissue sampling in 9; clinical follow-up of up to 2 years yielded no diagnosis in 10 and presumptive diagnoses in 12. The nondiagnostic biopsy rate of long bone lesions was higher than that of other bone lesions (odds ratio, 3.46; 95% confidence interval, 1.32-9.09). There were no significant differences in patient American Society of Anesthesiologists class, mean body mass index, sedation method, number of cores, or needle gauge between diagnostic and nondiagnostic biopsy cohorts. Diagnostic yield was not significantly different between occult, lytic, or sclerotic lesions. There was no difference in diagnostic yield regarding presence of cortical break, gadolinium enhancement, or lesion depth. Magnetic resonance imaging was obtained before biopsy in significantly more nondiagnostic cases compared with diagnostic cases ( P = 0.027).Computed tomography-guided biopsies had a nondiagnostic rate of 19.87%, and lesions in the long bones of the extremities were disproportionately common among this group. There was no significant association between biopsy results and several patient-specific, lesion-related, and technical factors.

OBJECTIVE: Deep learning (DL) image reconstruction has the potential to disrupt the current state of MRI by significantly decreasing the time required for MRI examinations. Our goal was to use DL to accelerate MRI to allow a 5-minute comprehensive examination of the knee without compromising image quality or diagnostic accuracy. MATERIALS AND METHODS. A DL model for image reconstruction using a variational network was optimized. The model was trained using dedicated multisequence training, in which a single reconstruction model was trained with data from multiple sequences with different contrast and orientations. After training, data from 108 patients were retrospectively undersampled in a manner that would correspond with a net 3.49-fold acceleration of fully sampled data acquisition and a 1.88-fold acceleration compared with our standard twofold accelerated parallel acquisition. An interchangeability study was performed, in which the ability of six readers to detect internal derangement of the knee was compared for clinical and DL-accelerated images. RESULTS. We found a high degree of interchangeability between standard and DL-accelerated images. In particular, results showed that interchanging the sequences would produce discordant clinical opinions no more than 4% of the time for any feature evaluated. Moreover, the accelerated sequence was judged by all six readers to have better quality than the clinical sequence. CONCLUSION. An optimized DL model allowed acceleration of knee images that performed interchangeably with standard images for detection of internal derangement of the knee. Importantly, readers preferred the quality of accelerated images to that of standard clinical images.

Rationale and Objectives The medial plantar proper digital nerve, also called Joplin's nerve, arises from the medial plantar nerve, courses along the medial hallux metatarsophalangeal joint, and can be a source of neuropathic pain due to various etiologies, following acute injury including bunion surgery and repetitive microtrauma. We describe our clinical experience with diagnostic ultrasound assessment of Joplin's neuropathy and technique for ultrasound-guided therapeutic intervention including both injection and cryoablation over a 6-year period. Materials and Methods Retrospective review of all diagnostic studies performed for Joplin's neuropathy and therapeutic Joplin's nerve ultrasound-guided injections and cryoablations between 2012 and 2018 was performed. Indications for therapeutic injection and cryoablation, were recorded. Studies were assessed for sonographic abnormalities related to the nerve and perineural soft tissues. Post-treatment outcomes including immediate pain scores, clinical follow-up, and periprocedural complications were documented. Results Twenty-four ultrasound-guided procedures were performed, including 15 perineural injections and nine cryoablations. With respect to sonographic abnormalities, nerve thickening (33%) and perineural hypoechoic scar tissue (27%) were the most common findings. The mean pain severity score prior to the therapeutic injection was 6.4/10 (range 4–10) and 0.25/10 (range 0–2) following the procedure; mean follow-up was 26.2 months (range 3–63 months). All of the cryoablation patients experienced sustained pain relief with a mean length follow-up of 3.75 months (range 0.2–10 months). Conclusion Therapeutic injection of Joplin's nerve is a safe and easily performed procedure under ultrasound guidance, with high rates of immediate symptom improvement. For those experiencing a relapse or recurrent symptoms, cryoablation offers an effective secondary potential treatment option.

PURPOSE To describe our experience using ultrasound (US) to evaluate postoperative complications in the presence of in situ shoulder arthroplasty. METHODS Review of patients who underwent US evaluation following total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RTSA) or hemiarthroplasty from 2007 to 2020. All studies were reviewed independently by two musculoskeletal radiologists to assess for joint effusion, periarticular collection, and characterization of associated rotator cuff tears. Tendon tears were assessed with respect to (1) thickness: low grade ( 50% thickness), full thickness; (2) morphology (focal vs. diffuse) and location (insertion vs. critical zone). Inter-reader agreements were determined using Cohen's kappa test. RESULTS Ninety-seven studies were performed in 72 patients following TSA, RTSA, or hemiarthroplasty. Thirty-seven exams were solely for diagnostic purposes, and 59 were for guiding joint or periarticular collection aspiration. Twenty-eight studies assessed the cuff tendons post TSA. The mean time between surgery and US examination was 29.2 months. Complete or high-grade tears were identified in 8/28 (28.6%) diagnostic exams. The most commonly torn tendon among TSA patients was the subscapularis, with 13/28 (46.4%) demonstrating at least partial tearing. Inter-reader agreement was excellent for presence of effusion (k = 0.79, p

PURPOSE: We aimed to retrospectively correlate (18)F-fluorodeoxyglucose ((18)F-FDG) metabolic activity with lumbar spine magnetic resonance imaging (MRI) findings and epidural steroid injection sites in patients with symptomatic degenerative disease of the lumbar spine. METHODS: A database search was conducted for patients receiving epidural injections

Osteoarthritis (OA) is the most common joint disease in the United States. The prevalence of OA is rising due to an aging population and increasing rates of obesity. Magnetic resonance imaging (MRI) allows an incomparable noninvasive assessment of all joint structures. Irreversible and progressive degradation of the articular cartilage remains the hallmark feature of OA. To date, attempts at developing disease-modifying drugs or biomechanical interventions for treating OA have proven unsuccessful. MRI-based cartilage imaging techniques have continued to advance, however, and will likely play a central role in the development of these joint preservation methods of the future. In this narrative review, we describe clinical MR image acquisition and assessment of cartilage. We discuss the semiquantitative cartilage scoring methods used in research. Lastly, we review the quantitative MRI techniques that allow assessment of changes in the biochemical composition of cartilage, even before the morphological changes are evident.

Objective The purpose of this study is to determine the most accurate imaging techniques to measure glenoid bone loss in anterior glenohumeral instability through a systematic review of existing literature. Materials and methods We performed a comprehensive literature search of five databases for original research measuring glenoid bone loss at radiography, CT, or MRI, using prospective or retrospective cohort, case-control, or cadaveric study designs up to January 2018. The Quality Assessment of Diagnostic Accuracy Studies-2 tool aided qualitative assessment of the methods. Data extraction included results, index test interobserver agreement, and accuracy analysis. Results Twenty-seven studies (evaluating 1425 shoulders) met inclusion criteria after full-text review by two independent readers. Glenoid bone loss was assessed, comparing several index tests to nonimaging (n = 18 studies) and imaging (n = 11) reference standards. Compared with arthroscopic or cadaveric measurements, 2D CT was accurate in six of seven studies (86%), 3D CT was accurate in eight of 10 studies (80%), 2D MRI was accurate in five of seven studies (71%), 3D MRI was accurate in four of four studies (100%), and radiographs were accurate in zero of four studies (0%). Best-fit circle methods (glenoid width or Pico surface area) were the most common and both were accurate (86-90% and 75-100%, respectively) using CT and MRI. Studies had good external validity (78%). Most risk for bias arose from patient selection and reference standards. Only two studies reported sensitivity and specificity, both comparing CT to arthroscopy using different bone loss thresholds (20% and 25%). Conclusion CT and MRI (2D or 3D) accurately measure glenoid bone loss in anterior shoulder instability, but radiographs do not. Best-fit circle measurement techniques are reliable and accurate. Current literature about glenoid bone loss is heterogeneous, and future studies should focus on diagnosis of clinically relevant glenoid bone loss.

The purpose of this study was to evaluate the mid-term results of posterior medial meniscal root tear (PMMRT) repair through assessment of functional outcome scores and magnetic resonance imaging (MRI).This was a single-center, retrospective study evaluating patients that had undergone a PMMRT. This was a follow-up to a previously published 2-year outcome study (all original patients were invited to participate). Clinical outcomes included pre- and postoperative International Knee Documentation Committee (IKDC) and Lysholm scores. Root healing, meniscal extrusion, and cartilage degeneration via International Cartilage Repair Society Scale (ICRS) grades were assessed on MRI by two musculoskeletal fellowship-trained radiologists.10 of the original study's 18 patients were able to participate. Mean age and BMI was 48.4 ± 12.0 years and 29.5 ± 4.5, respectively, with mean follow-up 65.5 ± 8.3 months (range 52.0-75.8) (60% female). The IKDC significantly increased from 43 ± 13 preoperatively to 75 ± 16 at 5-year follow-up (p 0.001). There was no significant change in IKDC score between 2-year and 5-year follow-up [75 ± 16 vs 73 ± 20, (n.s)]. The Lysholm also significantly increased between preoperative and 5-year follow-up (49 ± 7 vs 84 ± 11, p 0.001). There was no significant change between Lysholm score at 2-year and 5-year follow-up [84.0 ± 11 vs 82 ± 13, (n.s)]. Mean extrusion did not significantly change from the preoperative state to 5-year follow-up [4.80 mm ± 1.9 vs 5.0 mm ± 2.5, (n.s.)]. Extrusion also did not significantly change between 2-and 5-year follow-up [6.1 ± 3.2 mm vs 5.0 mm ± 2.5, (n.s.)]. No patients with 3 mm of extrusion on preoperative MRI had 3 mm of extrusion on postoperative MRI. Both medial femoral condyle and medial tibial plateau ICRS grades significantly increased from preoperative to 2-year follow-up (p = 0.038, p = 0.023, respectively). Medial femoral condyle and medial tibial plateau ICRS grades again significantly increased between 2-year and 5-year follow-up (p = 0.014, p = 0.034).Patients treated with the transtibial suture pullout technique with two locking cinch sutures had maintenance of clinical outcome improvements at 5-year follow-up. However, extrusion was widely prevalent, with worsening progression of femoral and tibial chondral disease.Level 4.

Ultrasound-guided hookwire localization was initially introduced to facilitate the excision of nonpalpable breast lesions by guiding surgical exploration, thereby reducing operative time and morbidity. The same technique has since found utility in a range of other applications outside breast and can be useful within the musculoskeletal system. Despite this, there remains limited literature with respect to its technical aspects and practical utility. We describe our technique and a series of preoperative ultrasound-guided wire localizations in the musculoskeletal system to assist surgical excision of 4 soft tissue masses.

There is a paucity of literature describing MRI patterns of high ankle sprains in pediatric patients. Radiologists should understand MRI patterns of these injuries in both adults and children.To describe normal MRI appearance of pediatric syndesmotic ligaments and compare MRI patterns of high ankle sprains in children versus adults.We reviewed consecutive ankle MRIs performed over 3 years and divided them into three cohorts: a normal pediatric (≤16 years) cohort, and pediatric and adult cohorts with acute/subacute ankle syndesmosis injuries. Our retrospective review assessed interobserver agreement (Cohen kappa coefficient) and normal pediatric syndesmotic anatomy. We compared patterns of high ankle sprains (Fisher exact test) including ligament tears, periosteal stripping, avulsions and fractures.Of the 582 ankle MRIs, we included 25 in the normal pediatric cohort, 20 in the pediatric injury cohort and 23 in the adult injury cohort. The anterior and posterior tibiofibular ligaments all attached to cortex or cartilaginous precursor, while the interosseous ligament/membrane complex attached to the fibrous periosteum in 22/25 (88%) normal pediatric cases. Tibial periosteal stripping at the interosseous ligament/membrane complex attachment occurred in 7/20 (35%) pediatric and 1/23 (4%) adult injury cases (P=0.02). No other statistically significant differences were found. Interobserver agreement ranged from kappa=0.46 to kappa=0.82 (ligament tears), 0.38 to 0.45 (avulsions) and 0.69 to 0.77 (periosteal stripping).The normal interosseous ligament/membrane complex typically attaches to fibrous periosteum rather than bony cortex. Tibial periosteal stripping, usually without tibial fracture, is significantly more common among pediatric high ankle sprains. MRI patterns of high ankle sprains are otherwise not significantly different between children and adults.

Normal skeletal development in the pediatric ankle is dynamic and often produces variable imaging appearances that are subject to misinterpretation. Radiologists must understand the underlying developmental phenomena, such as endochondral and membranous ossification and physeal fusion, and be familiar with their common and uncommon imaging manifestations unique to the pediatric ankle. This is especially true as the use of MRI in the evaluation of musculoskeletal trauma expands among younger populations. The authors focus on MRI evaluation of the skeletally maturing pediatric ankle and present pearls for accurately distinguishing normal findings and imaging pitfalls from true pathologic findings. The normal but often variable imaging findings of preossification, secondary ossification, and multiple ossification centers, as well as the range of bone marrow signal intensities that can be visualized within ossification centers, are described, along with tips to help differentiate these from true pathologic findings such as contusion, fracture, or tumor. The authors also review dynamic periosteal and physeal contributions to bone growth to highlight helpful distinguishing features and avoid misdiagnosis of common subperiosteal and periphyseal abnormalities. For example, the normal trilaminar appearance of the immature cortex and periosteum should not be mistaken for periosteal reaction, traumatic stripping, or subperiosteal hematoma. In addition, the physis can have several confusing but normal appearances, including normal physeal undulations (eg, Kump bump) or focal periphyseal edema, which should not be mistaken for pathologic findings such as physeal fracture, infection, or bar. ©RSNA, 2020.

Please see the Editorial Comment by Lauren Ladd discussing this article. BACKGROUND. Tearing of the superior peroneal retinaculum is a known cause of peroneal tendon subluxation-dislocation. Howeve...

The aims of this study are to assess the diagnostic yield of image-guided biopsy for discitis-osteomyelitis (DO), identify factors associated with biopsy yield (laboratory, pre-defined MRI findings, and biopsy technique), and impact of biopsy on management of patients appropriately selected according to the Infectious Disease Society of America guidelines (IDSA). This is a retrospective review of patients who underwent biopsy for suspected DO from 2011 to 2019. Reference standards to establish diagnosis of DO in order were histopathology/microbiology from biopsy or subsequent surgical sampling, positive blood culture or serology, and imaging/clinical follow-up. Laboratory markers, pre-biopsy antibiotics and MRI features, procedural-related variables, and impact of biopsy on management were assessed. Multivariable logistic regression was also performed. Out of 97 included patients, 78 were diagnosed with DO. Overall sensitivity of biopsy for detecting DO was 41.0% (32/78), including 10 patients with positive histopathology only, 14 with positive biopsy culture only, and 8 with both. Elevated ESR (p < 0.001) and epidural collection on MRI (p = 0.008) were associated with higher biopsy yield (63.6% and 68.6%, respectively) in a multivariable model. Procedural variables were not associated with yield. Biopsy results impacted the management in 19/77 (24.7%) patients, of whom 15/19 (78.9%) had treatment de-escalation and 4/19 (21.0%) had treatment escalation including starting new anti-tuberculous and anti-fungal regimens. Sensitivity of biopsy for detecting DO was 41.0%. When IDSA guidelines are followed, biopsy provided impactful information that changed the management in 24.7% of patients. Evaluation for elevated ESR and epidural collection can help improve yield and patient selection for biopsy.

BACKGROUND. Literature on glenohumeral dislocations has focused on younger patient populations because of high recurrence rates. However, the spectrum of injuries sustained in younger versus older ...

Purpose : To assess the utility of a 2D dynamic HASTE sequence in assessment of cervical spine flexion-extension, specifically (1) comparing dynamic spondylolisthesis to radiographs and (2) assessing dynamic contact upon or deformity of the cord. Methods : Patients with a dynamic flexion-extension sagittal 2D HASTE sequence in addition to routine cervical spine sequences were identified. Static and dynamic listhesis was first determined on flexion-extension radiographs reviewed in consensus. Blinded assessment of the dynamic HASTE sequence was independently performed by 2 radiologists for (1) listhesis and translation during flexion-extension and (2) dynamic spinal cord impingement (cord contact or deformity between neutral, flexion and extension). Results 32 scans in 32 patients (9 males, 23 females) met inclusion criteria acquired on 1.5 T (n = 15) and 3 T (n = 17) scanners. The mean acquisition time was 51.8 s (range 20–95 seconds). Dynamic translation was seen in 14 patients on flexion-extension radiographs compared to 12 (reader 1) and 13 (reader 2) patients on HASTE, with 90.6 % agreement (K = 0.83; p = 0.789). In all cases dynamic listhesis was ≤3 mm translation with one patient showing dynamic listhesis in the range 4−6 mm. Four cases (13 %) demonstrated deformity of the cord between flexion-extension, not present in the neutral position. For cord impingement there was strong inter-reader agreement (K = 0.93) and the paired sample Wilcoxon signed rank test found no significant difference between the impingement scores of the two readers (p = 0.787). Conclusions : A sagittal dynamic flexion-extension HASTE sequence provides a rapid addition to standard MRI cervical spine protocols, which may useful for assessment of dynamic spondylolisthesis and cord deformity.

The coda magnitude method of Mayeda and Walter (1996) provides stable source spectra and moment magnitudes (Mw) for local to regional events from as few as one station that are virtually insensitive to source and path heterogeneity. The method allows for a consistent measure of Mw over a broad range of event sizes rather than relying on empirical magnitude relationships that attempt to tie various narrowband relative magnitudes (e.g., ML, MD, mb, etc.) to absolute Mw derived from long-period waveform modeling. The use of S-coda and P-coda envelopes has been well documented over the past several decades for stable source spectra, apparent stress scaling, and hazard studies. However, up until recently, the method requires extensive calibration effort and routine operational use was limited only to proprietary US NDC software. The Coda Calibration Tool (CCT) stems from a multi-year collaboration between the US NDC and LLNL scientists with the goal of developing a fast and easy Java-based, platform independent coda envelope calibration and processing tool. We present an overview of the tool and advantages of the method along with several calibration examples, all of which are freely available to the public via GitHub (https://github.com/LLNL/coda-calibration-tool). Once a region is calibrated, the tool can then be used in routine processing to obtain stable source spectra and associated source information (e.g., Mw, radiated seismic energy, apparent stress, corner frequency, source discrimination on event type and/or depth). As more events are recorded or new stations added, simple updates to the calibration can be performed. All calibration and measurement information (e.g., site and path correction terms, raw & measured amplitudes, errors, etc.) is stored within an internal database that can be queried for future use. We welcome future collaboration, testing and suggestions by the geophysical community.

We have performed 3D simulations of underground chemical explosions conducted recently in granitic outcrop as part of the Source Physics Experiment (SPE) campaign. The main goal of these simulations is to understand the nature of the shear motions recorded in the near field considering uncertainties in a) the geological characterization of the joints, such as density, orientation and persistency and b) the geomechanical material properties, such as, friction angle, bulk sonic speed, poroelasticity etc. The approach is probabilistic; joints are depicted using a Boolean stochastic representation of inclusions conditional to observations and their probability density functions inferred from borehole data. Then, using a novel continuum approach, joints and faults are painted into the continuum host material, granite. To ensure the fidelity of the painted joints we have conducted a sensitivity study of continuum vs. discrete representation of joints. Simulating wave propagation in heterogeneous discontinuous rock mass is a highly non-linear problem and uncertainty propagation via intrusive methods is practically forbidden. Therefore, using a series of nested Monte Carlo simulations, we have explored and propagated both the geological and the geomechanical uncertainty parameters. We have probabilistically shown that significant shear motions can be generated by sliding on the joints caused by spherical wave propagation. Polarity of the shear motion may change during unloading when the stress state may favor joint sliding on a different joint set. Although this study focuses on understanding shear wave generation in the near field, the overall goal of our investigation is to understand the far field seismic signatures associated with shear waves generated in the immediate vicinity of an underground explosion. Therefore, we have abstracted the near field behavior into a probabilistic source-zone model which is used in the far field wave propagation.This work performed under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory under Contract DE-AC52-07NA27344

Previous studies have shown that explosion sources produce fewer aftershocks and that they are generally smaller in magnitude compared to aftershocks of similarly sized earthquake sources (Jarpe et al., 1994, Ford and Walter, 2010). It has also been suggested that the explosion-induced aftershocks have smaller Gutenberg-Richter b-values (Ryall and Savage, 1969, Ford and Labak, 2016) and that their rates decay faster than a typical Omori-like sequence (Gross, 1996). Recent chemical explosion experiments at the Nevada National Security Site (NNSS) were observed to generate vigorous aftershock activity and allow for further comparison between earthquake- and explosion-triggered aftershocks. Of the four recent chemical explosion experiments conducted between July 2018 and June 2019, the two largest explosions (i.e. 10-ton and 50-ton) generated hundreds to thousands of aftershocks. Preliminary analysis indicates that these aftershock sequences have similar statistical characteristics to traditional tectonically driven aftershocks in the region. The physical mechanisms that contribute to differences in aftershock behavior following earthquake and explosion sources are poorly understood. Possible mechanisms may be related to weak material properties in the shallow subsurface that do not give rise to stress concentrations large enough to support brittle failure. Additionally, minimal changes in the shear component of the stress tensor for explosion sources may also contribute to differences in aftershock distributions. Here, we compare aftershock statistics and productivity of the explosion-related aftershocks at the NNSS site to synthetic catalogs of aftershocks triggered by explosion sources. These synthetic catalogs are built by coupling strains that result from modeling the explosion source process with the SW4 wave propagation code with the 3D physics-based earthquake simulation code, RSQSim. We compare statistical properties of the aftershock sequence (e.g. productivity, maximum aftershock magnitude, Omori decay rate) and the spatiotemporal relationship between stress changes and event locations of the synthetic and observed aftershocks to understand the primary mechanisms that control them.Prepared by LLNL under Contract DE-AC52-07NA27344.

To evaluate change in patient-reported outcomes following image-guided intra-articular therapeutic steroid hip injections for pain and assess correlations of outcomes with patient- and injection-specific factors. We retrospectively reviewed consecutive patients treated for hip pain who completed outcomes assessments from October 2011 to September 2017 at an outpatient orthopedic surgery clinic. Only patients with radiographic hip osteoarthritis (Tonnis grade ≥ 1) who underwent steroid hip injections were included. Outcomes assessments included EuroQol-5 domain (EQ5D), EQ5D-visual analog scale (VAS), and hip disability and osteoarthritis outcome score (HOOS), obtained before and within 1–6 months post-injection. Among 113 patients who completed surveys, the mean age was 59 years (±13.7 years), including 77 women (68%) and 36 men (32%). Time to repeat injection or arthroplasty was recorded. Exact Wilcoxon signed rank test assessed score differences and Spearman correlation, Kruskal–Wallis, and Mann–Whitney tests assessed correlations. Of 113 patients, 34 had outcomes measured at

The objective of this article is to review the normal anatomy and posttraumatic findings of the Chopart joint complex. Key imaging features of the normal ligaments and patterns of ligamentous and osseous injuries are discussed.Traumatic midtarsal injuries, particularly midtarsal sprain, are often overlooked clinically and on imaging but are relatively common and typically are associated with inversion ankle injuries. Radiologists should be familiar with Chopart joint anatomy and the imaging features of midtarsal injuries because early diagnosis may help optimize clinical management.

To correlate patterns of 18F-FDG uptake on whole-body PET-CT with MR findings and compare the degree of FDG activity between symptomatic and asymptomatic knees. Retrospective database query was performed using codes for knee MRI as well as whole-body PET-CT. Patients with malignant disease involving the knee or hardware were excluded. Patients who had both studies performed within 1 year between 2012 and 2017 were included for analysis. Knee joint osteoarthrosis, meniscal and ligamentous integrity, presence of joint effusion, and synovitis were assessed and recorded. Bone marrow edema lesions (BMELs) were identified, segmented, and analyzed using volumetric analysis. SUVmax was assessed over the suprapatellar joint space, intercondylar notch and Hoffa’s fat pad. Symptomatic and asymptomatic knees were compared in patients with unilateral symptoms. Twenty-two cases (20 patients) with mean age 63.3 years (range, 36–91 years) were included. Two patients had bilateral pain. The most FDG avid regions in both symptomatic and asymptomatic knees were the intercondylar notch (SUVmax = 1.84 vs. 1.51), followed by suprapatellar pouch (SUVmax = 1.74 vs. 1.29) and Hoffa’s fat pad (SUVmax = 1.01 vs. 0.87). SUVmax was significantly associated with cartilage loss (mean modified Outerbridge score) (r = 0.60, p = 0.003) and degree of synovitis (r = 0.48, p = 0023). Overall, mean SUVmax was significantly higher in the presence of a meniscal tear (1.83 ± 0.67 vs. 1.22 ± 0.40, p = 0.030). Nine patients had BMELs (volume: range = 0.6–27.8, mean = 7.79) however there was no significant association between BMEL volume and SUVmax. Higher FDG activity correlates with intra-articular derangement and the intercondylar notch represents the most metabolically active region of the knee.

Injuries at the calcaneocuboid and talonavicular joint have been described as two distinct, unrelated entities in the radiology literature. Our purpose was to assess the coexistence of these injuries using radiography and MRI and to correlate our findings with radiologic and clinical diagnoses.Twenty-one patients with injury at the anterior calcaneal process on radiographs or MR images were retrospectively assessed for concomitant injury at the talonavicular joint. Radiologic and clinical diagnoses and treatment were documented. McNemar and kappa statistics were calculated; p values0.05 were considered statistically significant.Radiographic and MRI rates of detection of injuries across the Chopart joint were statistically different. Calcaneocuboid avulsion fractures were evident on 48% of radiographs and 100% of MR images (p = 0.001). Talonavicular joint injuries were evident on 38% of radiographs and 76% of MR images (p = 0.008). Concomitant injury at both joints was evident on 14% of radiographs and 76% of MR images (p0.0001). Interrater agreement was 0.488-0.637 and 0.286-0.364 for talonavicular and 0.144-0.538 and 0.976-1 for calcaneocuboid injuries on radiography and MRI, respectively. Sixty percent of calcaneocuboid fractures were prospectively missed on radiography (none on MRI), whereas 38% and 25% of talonavicular findings were missed on radiography and MRI, respectively. Sixty percent of injuries were clinically misdiagnosed as ankle sprains. Chopart joint injury was never mentioned in prospective clinical or imaging diagnoses.Calcaneocuboid and talonavicular injuries commonly coexist. Radiographs underestimate severity of injury; MR images show more subtle abnormalities. Lack of mention of Chopart joint injury clinically and on imaging reports underlies the need for greater familiarity with this entity.

To review the MRI appearance of medial patellofemoral capsuloligamentous plication (also known as reefing or imbrication) for proximal patellar realignment in patients with patellofemoral instability. Retrospective analysis of our surgical and PACS databases identified cases of medial plication performed between June 2011 and July 2016. Pre- and postoperative MRI characteristics were reviewed. Correlation was made with operative reports and clinical records to define postoperative appearances on MRI. Forty-one patients underwent medial plication during the study period; 29 were excluded owing to a lack of postoperative imaging. Ultimately, 12 knees were included in 11 patients who had postoperative MRI studies available (8 women and 3 men, mean age 27.3 ± 10.2 years). Ten (83%) of the surgeries were performed open and 2 (17%) arthroscopically. There were differences in the post-surgical MRI appearance of medial plications carried out after surgery using the open and arthroscopic techniques. The open technique produces a “heaped up” distal vastus medialis obliquus (VMO) with centralized patellar insertion (100%), which was absent in the case of arthroscopic plication, where subtle medial retinaculum thickening was demonstrated without alteration of its patellar insertion. The mean postoperative lateral patellar and patellofemoral congruence angles measured 2.5° ± 5.6° and 12.4° ± 19.9° respectively. A significant association was found regarding change in patellofemoral alignment (p = 0.018 and p = 0.004 respectively). The MRI appearance of medial plication is not well described in the radiology literature; radiologists should be familiar with anticipated post-plication findings to avoid potential confusion for pathology and allow more accurate interpretation of postoperative imaging findings from this common surgery.

We describe an easily constructed, customizable phantom for magnetic resonance imaging-ultrasound fusion imaging and demonstrate its role as a learning tool to initiate clinical use of this emerging modality. Magnetic resonance imaging-ultrasound fusion can prove unwieldy to integrate into routine practice. We demonstrate real-time fusion with single-sequence magnetic resonance imaging uploaded to the ultrasound console. Phantom training sessions allow radiologists and sonographers to practice fiducial marker selection and improve efficiency with the fusion hardware and software interfaces. Such a tool is useful when the modality is first introduced to a practice and in settings of sporadic use, in which intermittent training may be useful.

Purpose To correlate shoulder ultrasound and radiography with F-FDG PET-CT to establish FDG uptake and therefore range of metabolic activity, as defined by SUV analysis, in various symptomatic shoulder pathologies. Methods Retrospective database query was performed for shoulder ultrasound and PET-CT scans between January 2012 and January 2017. Patients who had both studies within 1 year were included. Age- and sex-matched control patients with PET-CT scans only were also included. Retrospective image review determined shoulder pathology, and F-FDG SUVmax was measured using regions of interest placed at the glenohumeral joint, rotator cuff/bursa, and bicipital groove. Glenohumeral and acromioclavicular osteoarthrosis was assessed by radiography using the Kellgren-Lawrence classification system. Results Thirty-three patients had both imaging studies within 1 year. Ten patients (11 cases) were included, ranging in age from 56 to 90 years (mean, 67.9 years). Control subjects were selected among patients receiving PET-CT within 1 week of symptomatic patients. Glenohumeral osteoarthrosis was mild in 3 (27%), moderate in 2 (18%), and severe in 2 (18%). Six full-thickness rotator cuff tears (55%) were identified. SUVmax means were compared between the pathologic and control groups and were significantly higher in the former: glenohumeral joint (1.96 vs 1.32; P = 0.016), rotator cuff/bursa (2.80 vs 2.0; P = 0.005), and bicipital groove (2.19 vs 1.48; P = 0.007). The highest values were seen in full-thickness rotator cuff tear and severe biceps tenosynovitis. Conclusions Increased metabolic activity about the shoulder is associated with a spectrum of rotator cuff, glenohumeral joint, and other soft tissue pathology that can be correlated with diagnostic ultrasound findings.

We performed relative locations of six event-pairs based on surface-wave (SW) and body-wave (BW) differential travel-times of the 2016-09-09, 2016-01-06, 2013-02-12, and 2009-05-25 announced North Korea nuclear explosions. The SW relative locations for the 2009-05-25 and 2013-02-12 events were inconsistent with the BWs when paired with other events and only the 2016-01-06/2016-09-09 pair was consistent. Apparent SW phase shift is investigated with respect to the BW relative locations. The pairs formed with the 2009-05-25 and 2013-02-12 events, beneath the southeast slope of Mount Mant'ap, have the largest phase shifts and amplitude ratio deviations, whereas the least deviation was from the 2016-01-06 and 2016-09-09 event-pair beneath the mountain peak. Regional moment tensors (MTs) predict the amplitude ratios but do not resolve the relative phase. We find MTs with 10% difference in isotropic and rotated +CLVD can fit both relative phase and amplitude ratios. SW relative locations of highly isotropic and correlated explosion clusters can be affected by topography and small differences in MT.